7 Drugs That Affect Your Nails: Chemotherapy, Retinoids, Antibiotics, and More
Key takeaways:
If your nail health has taken a turn for the worse, a new medication could be the culprit. These types of changes are most common with cancer medications. But in rare cases other medications may contribute to them, too.
Most nail changes are cosmetic and shouldn’t affect your holistic health in a significant way. There are effective treatments to consider, too — even if you have a skin infection around your nails or if your nails are separating from your nail beds.
Discuss any concerning nail changes with your healthcare professional. If you’re taking any drugs that affect your nails, they can recommend ways to get these side effects under control.
Table of contents
Your nails may be an important part of your self-expression — and even your culture. But, in rare cases, you may experience nail changes after starting a new medication. A select number of drugs are associated with side effects that affect your fingernails and toenails.
Most nail changes are cosmetic in nature. And they may resolve after stopping the offending medication. But, in other circumstances, your symptoms may be more serious or long-lasting. No matter the situation, there are steps you can take to get your nails back to normal.
Here, we’ll discuss a few drugs that affect your nails, preventive measures you can take to help keep your nails healthy, and some treatments you may want to explore.
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What are drug-induced nail changes?
Drug-induced nail changes are nail-related side effects that you may develop after starting a new medication.
Some medications cause minor symptoms, such as cosmetic changes to your nail color. Other changes may be more serious and involve infection and your nails separating from your nail beds.
Nail-related symptoms may go away after stopping certain medications. However, you shouldn’t ever stop taking your medication without contacting your healthcare professional (HCP) first.
In more hopeful news, nail problems are not a common occurrence with most medications. They’re mostly linked to a select few. Here are the top seven medications to keep in mind.
Looping in an expert: Not everything can be treated at home. Learn about the situations where you may want to see a healthcare professional for nail changes.
Spotting a nail infection: This can be tricky. Here are a few different ways you can identify a potential infection.
Psoriatic arthritis nail symptoms: Several health conditions can affect your nail health. Understand the ways psoriatic arthritis can affect your nails.
1. Chemotherapy
Chemotherapy medications, such as bendamustine (Treanda) and doxorubicin, treat solid tumors and blood cancers. They do this by fighting fast-spreading cancer cells. But, at the same time, chemotherapy can attack rapidly dividing cells in your body that aren’t cancerous. This includes hair cells, stomach cells, and nail cells.
When it comes to chemotherapy-induced nail problems, your specific nail changes will depend on the medication(s) you’re taking. Possible nail-related side effects include:
Horizontal grooves running side to side
Horizontal white bands running side to side
General discoloration or color changes
Black or brown discoloration
Bleeding underneath or around your fingernails
Several of these changes are cosmetic in nature. But they may persist for several years after you complete your chemotherapy regimen. If desired, you can apply colored nail varnish to hide cosmetic changes that you don’t like.
In other cases, you may experience more substantial nail problems. This can include changes such as your nails separating from the skin or skin infections around your nails. Talk to your oncologist right away if you’re experiencing symptoms like these. If needed, they can prescribe antibiotics or perform minor surgical procedures to put you on your path back to better nail health.
2. EGFR inhibitors
Epidermal growth factor receptor (EGFR) inhibitors, such as erlotinib (Tarceva), are targeted medications that treat cancer. Similarly to chemotherapy, they can also affect your nail health.
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Most people experience some degree of nail-related symptoms within 2 months of starting an EGFR inhibitor. You may experience one or more of the following symptoms:
Skin infection around the side of your nails
Separation of the nail from your nail bed
Black or brown discoloration
Nail brittleness
Small blood vessel growths around the nail (called pyogenic granuloma)
These symptoms are generally cosmetic, but they may affect multiple or all of your nails. Your oncologist can help you manage this issue if it occurs.
3. Retinoids
Isotretinoin (Claravis) and acitretin are two examples of oral retinoids. They normally treat acne and psoriasis, respectively, but they also can affect your nail health.
Isotretinoin can speed up how fast your nails grow. Over time, this can lead to thinner nails. However, in clinical studies, this effect hasn’t been substantial. It may not even be noticeable. A different report found that acitretin may rarely cause your nail surfaces to become rough like sandpaper.
Speak to your HCP if you have concerns about your nails changing after starting a retinoid. They may be able to adjust your dose or stop your medication depending on the severity of your condition.
4. Several antibiotics
You may notice changes to your nails after taking certain antibiotics.
Tetracycline antibiotics — such as tetracycline and doxycycline (Vibramycin) — are very rarely associated with cosmetic changes in the color of your nails. This effect is slightly more likely to happen in kids. In most cases, though, you won’t need to do anything in response to it. These antibiotics are usually only taken for a few days or weeks at a time, and this type of discoloration is usually temporary.
In rare cases, you may experience more serious nail changes with antibiotics. Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro), and tetracyclines, such as doxycycline, are sometimes associated with nails separating from the skin beneath them after exposure to sunlight.
Speak to your HCP in the rare case you experience a nail-related side effect from your antibiotic. They can recommend treatments or management tips based on your symptoms, such as cutting your fingernails or soaking them in a dilute vinegar solution.
5. Several anti-seizure medications
Anticonvulsants, also known as anti-seizure medications, are very rarely associated with nail alterations.
Valproic acid (Depakene) is one example. In one report, a person experienced nail discoloration, roughness on the surface of their nails, and nail separation from their nail beds. Their symptoms resolved after stopping valproic acid.
Another individual experienced nail discoloration and separation from nail beds after taking carbamazepine (Tegretol). This also resolved after they stopped taking it. Phenytoin (Dilantin) may cause nail bed discoloration in rare cases, too.
If you’re taking an anti-seizure medication, it’s important to communicate any concerning symptoms, including nail changes, with your HCP. They can switch you to another medication, if needed, and your symptoms may resolve after stopping the offending medication.
6. Certain blood thinners
Blood thinners (anticoagulants) may also cause nail-related symptoms. Popular examples of anticoagulants include warfarin (Coumadin, Jantoven), rivaroxaban (Xarelto), and dabigatran (Pradaxa).
Blood thinners may promote bleeding under your nails. You may have experienced bleeding under your nails if you’ve accidentally hit your fingernail while hammering in a nail or stubbed your toe under a piece of furniture. But if you’re taking a blood thinner, you may experience this symptom even if you don’t accidentally bang your nails on anything.
Notify your HCP if you develop any bleeding under your nails. They may want to adjust your blood thinner dose.
7. Lithium
Lithium (Lithobid) is a popular bipolar disorder medication. It’s been linked to nail changes in very rare cases. One report found that lithium may cause fingernail psoriasis. Lithium may cause nails to become thicker, yellow, and have a rough surface about 1 month after starting it. These types of symptoms should go away after you stop taking lithium.
How do you treat nails affected by medication?
If your medications are causing changes to your nail health, you don’t have to wait around and hope the situation improves. Treatments and other management tips are available. Your specific treatment will depend on the nail-related symptoms that you’re experiencing.
If your nails are weak and brittle, applying emollients and a poly-ureaurethane (Nuvail) or hydrosoluble nail lacquer (Genadur) can help protect and strengthen them. Keep them trimmed short and use cotton gloves under latex gloves for doing wetwork (like cleaning or washing dishes).
Topical steroids and antibiotics may help if you’re experiencing a skin infection when your skin meets the sides of your fingernails. Your HCP may also direct you to keep your nails short or soak your nails in a dilute vinegar solution.
Contact your HCP if your nails are separating from your nail beds or if you notice small blood vessel growths around your nail that bleed. They may need to perform a minor procedure to relieve your symptoms. You may need to apply topical antibiotics, too. You should also contact them for treatment if you have a pus-forming wound around your fingernails. They may need to take a bacterial culture and prescribe you an antibiotic.
Can you prevent drug-induced nail changes?
You can reduce your chances of developing nail problems by taking a few proactive measures. Do your best to avoid:
Pressure and trauma to your nails
Aggressive manicures
Wearing tight footwear
Using chemicals like acetone on your nails
Frequently submerging your nails in water
Applying artificial nails
Biting your nails
Cutting your nails too short
Medication-specific recommendations are also available. For example, wearing Elasto-Gel frozen gloves and socks may help prevent nail changes while you’re receiving infusions of taxane chemotherapy medications, such as docetaxel (Taxotere).
The bottom line
Some medications may cause nail-related side effects. This includes chemotherapy medications, EGFR inhibitors such as erlotinib (Tarceva), retinoids such as isotretinoin (Claravis), and more. Most drug-induced nail changes are cosmetic and harmless, but others may require medical intervention.
Talk to your healthcare professional (HCP) if you’re experiencing bothersome nail changes. Several treatment options are available, ranging from topical medications and vinegar solutions to minor surgical procedures. You can also take preventive measures to reduce your likelihood of drug-induced nail changes. Try to avoid wearing tight footwear, biting your nails, and applying artificial nails.
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References
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